Lisinopril (Prinivil, Zestril) is one of the most commonly prescribed blood pressured medications in the world. It belongs to a class of drugs called ACEis (angiotensin converting enzyme inhibitors) that includes:

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Such drugs are effective for helping control hypertension and many people take these medications without experiencing any side effects. That’s the good news.

The bad news is that some people are susceptible to a potentially lethal complication of ACE inhibitors called angioedema. In this condition tissues around the face and neck can swell rapidly. Without immediate emergency treatment angioedema can be life threatening. The symptoms can surface within a few hours or days after starting on the drug. But even people who have been on an ACE inhibitor for months or years can develop angioedema.

At the very first symptoms of swelling do not delay: CALL 911 and be transported to an emergency department instantly! Don’t just take our word for it. Here is a recent report posted to our website from Dennis:

“On October 8 I saw my doctor and was prescribed 20 mg of lisinopril 3 times a day. I thought, ‘Great, now I have some meds to help with my high blood pressure.’ I think I was around 185 over 110 which the doctor said was pretty high.

“By the 12th of October my tongue had been swelling every day to the point that breathing was getting very difficult. This was all happening by the fourth day of taking my new blood pressure medicine.

“My son took me to the ER on the 12th. The nurse in ER took my readings and said my blood pressure was in heart attack territory at 225 over 170. I was taken back to a room to be examined, as my tongue was swelling so much. Not one doctor knew what to do. I really thought I was going to die from suffocation, as breathing was almost impossible at this point.

“By this time other family members were arriving and for two weeks I don’t remember anything other than what I was later told by family and doctors. The doctors put me in an induced coma. Doctors had to do surgery and perform a tracheotomy so I could breathe during my coma.

“They diagnosed me with angioedema caused by taking lisinopril!

“During my coma I developed pneumonia and also had to be put on dialysis. The doctors told my family that they should all be nearby because I wasn’t expected to live through this ordeal. They told family members only about a half percent of patients make it through a situation like mine.

“When I woke up from my coma after two weeks I couldn’t walk, talk, or even write a simple sentence. I started my therapy in the hospital and it sure was difficult. After great hospital care and help from family and rehab I was able to walk and talk and write again. It seemed like it took forever but my goal was to do my rehab and be home by Thanksgiving. I pushed hard and did accomplish my goal but I don’t think I deserved to almost die and lose two months of my life for something that was not my doctor’s fault or mine.

“When my doctor saw me next he let me know he was so sorry and told me he kept checking up on my health daily. He even cried when we talked about my ordeal. People taking lisinopril need to know about the hazards of this drug.”


Dennis was lucky indeed to have survived. His angioedema reaction came on within days of starting lisinopril. Other people may let down their guard because they have taken an ACE inhibitor safely for years. Here is Ruth’s story:

“My brother was on lisinopril for two to three years with no problems other than a irritating cough. However, last month, he woke up with a very swollen tongue. By the time he got to the ER, his respirations were down to about 85% and he was having trouble talking.

“The ER called for an emergency triage and the ER doctor came out, rushed him into a room, actually helping strip his clothes on the way. They gave him adrenaline, and IVs. They told him if he had been a little later waking up he might not have made it, and that most people with this serious a reaction can end up on a ventilator.

“Don’t mess with swelling of the mouth or trouble breathing. It could be a bad reaction. We are only five minutes from the hospital, and he was terribly close to stopping breathing and ending up on a ventilator.”


 Symptoms of Angioedema

Any swelling of tissues around the face, mouth and throat are a tip-off that something bad is happening. Some people report numbness or decreased feeling in the affected area. The eyes and lips can also be involved. If the throat and tongue swell, there can be the sensation of throat tightness and breathing can become difficult or impossible.

Abdominal Angioedema

Angioedema is not restricted to the head and neck. Hands and genitals can also be affected. When angioedema strikes the intestines, it can cause abdominal swelling or distension and in some cases bowel obstruction. We have heard from many patients that this condition can be hard to diagnose. Here are some stories:

“I was put on lisinopril for high blood pressure in January. That month I experienced severe stomach cramping and vomiting. I was rolling on the floor in agony. The doctor said it was most likely the flu but started me on two different antibiotics in case it was bacterial.

“A few weeks later I had another attack with severe stomach cramping and vomiting. I went to the ER, where I was given IV pain meds. A CT scan showed small intestine inflammation partially blocking off my bowel. I was sent home but returned the next day with pain that was a 10 on a 10-point scale. The doctor said that all the tests had been done and there was nothing he could do. I was sent home with pain medication.

“A few weeks later I was admitted to the hospital with increased small intestine inflammation and another blockage. I vomited and dry-heaved for 12 hours. I was released four days later with no definitive diagnosis.

“I was told most likely I had Crohn’s disease, but a colonoscopy was negative for Crohn’s. I underwent extensive tests, including endoscopy, and all were negative. None of the doctors made a connection with the drug lisinopril.

“After two months of missing work, three more ER visits and untold suffering, I found several other people who reported similar symptoms connected to lisinopril. I stopped the medication and have not had another attack. If you look on PubMed you can see reports on lisinopril and intestinal angioedema, but doctors don’t think to connect this with lisinopril because it is not listed as a common side effect.”

Another visitor to our website responded: “I feel your pain, trust me. This reaction to lisinopril is the worst pain I’ve ever had, worse even than labor. It was ridiculous that they did so many tests and still couldn’t figure it out for so long.

“I know doctors think this is really rare. I had to look up the exact words ‘intestinal angioedema lisinopril’ to find it online. But I think all of the side effects should be listed. My doctors were considering removing part of my intestine at one point. If only they had realized sooner that lisinopril was the cause, I wouldn’t have suffered so long.”


“I too have been experiencing a lot of mysterious abdominal pain after switching the brand of lisinopril I was taking. After months of abdominal attacks that came with ‘allergic type’ reactions, I finally had to go to the ER because of an anaphylactic reaction.

“I was referred to an allergist who listened carefully and told me that it could be from the lisinopril. It has now been two days since I stopped taking it and I have no abdominal pain at all. I have not been pain free for 5 months and am so grateful for an observant doctor.” N.G.


“Yes this drug does cause angioedema. At least you were lucky enough (considering all you dealt with) to be diagnosed and treated in a few weeks. I had angioedema in my intestine and it took over two and a half months for doctors to figure out that it was the Lisinopril because it’s such a rare reaction. They couldn’t believe I didn’t have the swelling in my mouth, throat, etc. as well.

“I don’t blame the doctors because not everyone reacts to medications the same. Unfortunately you don’t know if you’re allergic until you take it. There were only 22 reports of my allergy to it from 2000 to 2010 out of 80,000+ reports of various side effects.

“I wish pharmacies put the rare reactions on the info they give you about drugs but they usually only list the ‘common’ side effects. I am glad you are better. It’s a long road to recovery. I had two surgeries and spent a month in the hospital because of this medicine.” Christie


ACE inhibitors can trigger other side effects besides angioedema. The most notorious is a dry, hacking cough that is uncontrollable with cough medicine. This cough can be terribly disruptive and lead to vomiting. Getting a good night’s sleep can be challenging if you are susceptible to an ACEi-induced cough. To read more about this surprisingly misdiagnosed adverse drug reaction, check this link.

ACE INHIBITOR (LISINOPRIL) SIDE EFFECTS:

  • Dry cough, uncontrollable cough, nausea, vomiting
  • Dizziness, excessively low blood pressure
  • Kidney function changes, BUN & creatinene elevations
  • Headache
  • Digestive distress, diarrhea, abdominal pain
  • Tiredness, fatigue, malaise
  • Excessive potassium levels (requires immediate medical attention!), irregular heart rhythms, chest pain
  • Elevated uric acid levels
  • Sensitivity to sunlight (photosensitivity), skin rash
  • Angioedema (swelling of face, lips, tongue, throat)
  • Angioedema (swelling in abdomen, severe abdominal pain)
  • Severe allergic reaction (anaphylaxis) requiring emergency treatment
  • Toxicity to liver or pancreas
  • Blood disorders
  • Potential birth defects if taken during early pregnancy
  • Sexual difficulties

Anyone who would like to learn more about non-drug approaches to controlling hypertension may find our Guide to Blood Pressure Treatment of interest. There is also information about other medications for dealing with blood pressure problems.

Share your own ACE inhibitor story (positive as well as negative) below in the comment section.

 

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  1. Nancy
    Florida
    Reply

    My husband was given a prescription for lisinopril 5mg once per day. He took the first dose on a Tuesday night before bed. By 10 a.m. the next day his lips and lower face had swelled at least three times their normal size. Called his doctor who said to stop taking the lisinopril and take him to the ER if his throat or tongue showed any sign of swelling. Fortunately, the swelling did not progress to his tongue or throat and Benadryl is relieving the facial swelling.

    It’s looking like he will pretty much be back to normal at the 48 hour mark. Husband is African-American, so I’m a little surprised he was given even a very low dose of lisinopril considering African-Americans are at a greater risk of lisinopril-related angioedema. While the doctor knew exactly what was happening when he got on the phone with me, the nurse who first took my call at his office sounded as though she didn’t think the lisinopril had anything to do with the swelling.

    I had read the insert that came with the prescription and told her that the lisinopril had to be the cause. For such a widely prescribed medication, it surely seems like there needs to be more awareness among patients and healthcare professionals of these serious side effects.

  2. Shelby Martinez z
    Pueblo Colorado.
    Reply

    My first encounter with the sister medication of lacinapril called Ramifil was anything short of a nightmare . My doctor prescribed Ramapril to assist my blood pressure. After only taking Ramifil for 4 days I woke up with my lips swollen. I thought my lips were going to explode. I went to the er right away. The Dr came to the conclusion that it was a reaction to Ramapril . Thank God there were no long term symptoms. Never took another pill. Now, a year and a half later my Dr gave me lisinapril. Not thinking that the two drugs were related i started taking the pill I had just taken a pill a day for 3 days and my lips started swelling. Went to er . they were thinking it was a food allergy. Was admitted to the hospital. Prior to the lips swelling I developed a dry hacking cough. Dr told me it was allergies. While I was in the hospital I remembered the incident that happed a year and a half ago. I never took another pill. Now I’m hoping the cough is not permanent. If you are allergic to lisinipril. Don’t take any of the pril meds. They will probably have the same effect.

  3. J.
    kansas
    Reply

    My husband was put on it for diabetes, and he is now in the hospital with near fatal angio edema. The metformin has caused him to have lactic acidosis too. What the heck is going on with these new drugs??? Is no one testing them thoroughly? His health is severely threatened right now by all these magic drugs that were supposed to be so wonderful.

  4. Allen
    Reply

    I’ve always had high blood pressure even as a teenager. I didn’t start taking meds for my blood pressure till I was in my mid twenties and over the years I have taken taken different types of pills for it. So about a year ago I got stationed in Italy and the doctor put me on Lisinopril, during that time I found my self always tired, and started to gain weight. Well about 7 month in taking the pill I notice my face looked puffy and then the next day it was worse and I had a hard time waking up. So I stopped taking the pill and was able to make an appointment 6 days later . In those 6 days I losed 12 pounds, I’m guessing it was water my body was storing. The doctor told me I had angioedema, I am now on a different blood pressure meds. If I would of known how serious my situation was I would of went to the emergency room. I count my self lucky that nothing serious happened to me.

  5. Paul
    40475
    Reply

    I thought I was dying and the doctor kept saying my symptoms where not a known side effect

  6. Thankful
    Tennessee
    Reply

    I’ve taken Lisinopril for several years with no major problems except some light headedness. The last few months I’ve experienced bouts of severe nausea and vomiting. Complete misery. Then last night my lips started swelling out of control. My upper lip touched my nose it was so big. My tongue and cheeks were tingling. I took 3 Benadryl but no relief. My son them took me to the ER and the doctor knew right away it was Lisinopril related. I had to get an IV of steroids and other histamine inhibitors. Slowly I recovered. Am still on steroids. My primary care doctor did not know about the possibility of this side effect. I shudder to think what would have happened if I had not gone to the ER and had taken my usual evening dose of Lisinopril. I could be dead or brain damaged from lack of oxygen. Thank God He watches out for me and “nudged” me to go to the ER! I’m looking forward to no more nausea and no more anaphylaxis!

    • Wally
      Mi
      Reply

      Hello what are you taking now

    • Debra
      Moorestown, NJ
      Reply

      Just last week, I had an allergic reaction to Lisinipril after taking it for over 2 years with thinking I was having no problems. My whole face, lips, eyes, cheeks swelled beyond recognition. It took a few hours to get really bad, but my family took me to the ER , and thankfully got me there before I had any trouble breathing. The doctor knew immediately that it was Lisinipril when I told him I took it. I had to be admitted to the hospital for a few days to be treated then released under the care of an allergist and even a cardiologist to monitor me for some funky heart arrhythmias. I was so surprised at the side effect of this drug, because my primary physician really never warned me to look out for any of the symptoms, and he is always so good about these things! Anyway, I’m very thankful I am ok now, and have epinephrine on hand in case I ever have an allergic reaction again. It’s such a frightening experience and life threatening. Please be aware and talk to your doctors about any and all medications prescribed to you and your family members. Thank you for reading my story.

  7. frances
    Reply

    I took lisiniprol and had uncontrollable cough….sounds like a good thing I got off it. It took months after stopping for the cough to be completely gone. I am very sensitive to medications and have had to stop all ace inhibitors period.

  8. lois
    USA
    Reply

    I am so glad I came across this. My son has been put on 20mgs of this and he can’t stop coughing. He isn’t going to be taking this again.

  9. Billy
    Mo
    Reply

    I have been taking lisinopril(10 mg) for mild high blood pressure for several years with no major problems. Then last night before going to bed I took my meds including lisinopril and noticed my mouth area started to feel numb. I went to bed and woke up with no feeling around my mouth. I got up and looked in the mirror and I looked like chimpanzee. My lips and cheeks around my mouth were greatly swollen. I put an ice pack on the area for about an hour and no results. My wife then drove me to the emergency room, where I was hooked up to an IV and given several drugs. The ER Dr said it was more than likely an allergic reaction to the lisinopril. He gave me two prescriptions and released me. Told me to stop the lisinopril and see my regular Dr as soon as possible. I am home now and the swelling has gone down some but still not back to normal. Scary night.

  10. Linda
    Florida
    Reply

    I started Lisinopril 20 MG 1 tablet a day about a year and 1/2 ago. In the last few months I’ve begun having memory issues and some confusion. I have had my thyroid removed (3 surgery’s over several years. ) The last surgery was a few years ago. I have an appointment with an Endocrine specialist in January (1st available appointment). I’m wondering if these memory issues could be related to NO thyroid or possibly the Lisinopril? I’m 72, still work – because I enjoy it, but am concerned about my memory issues.

  11. Lisa
    Ca.
    Reply

    I lost my partner of 15years. He was on Medical and treated at the local county hospital. He was on the same drug you are talking about. He died 9-9-15. As had happened before after lying down to go to sleep I could hear moaning. Ran into his room. He was saying I can’t breath I feel like my stomach in in my throat. He was on oxogen and took the mask off asked me to crank it up but he couldn’t get any oxogen. I called nine one one. Last time they came and transported him he was in the hospital This time they didn’t get to him on time he died in bed and they wouldn’t try to revive him. I’ve always thought it was an alergic reaction but none of the many doctors or visiting nurses picked up on it. They gave him a rescue inhaler for wheezing which we never used as he never had wheezing per say. I am left wondering if it would have saved his life. I hope they take this medicne off the market all together. Yes he was recently put on potassium that had side effects too. As I wan’t a legal spouse doctors ignored me. I surley miss my friend. and lover.

  12. Tracy
    Reply

    I began Lisinopril about 3 months ago. I developed the slight dry cough initially. I was initially happy that my blood pressure had decreased, however; then my blood pressure started creeping up and my dosage was doubled. I developed ear wringing, welts on my fingers and my cough worsened so much that I was having trouble at work and it would lead to vomiting. I had developed allergy like symptoms so bad that I never have had, so much congestion that my ear drum burst. I have relayed all of this to my doctor who kept focusing on my development of allergies and not lisinopril, I even told her I thought it could be the lisinopril. She diagnosed the welts on my fingers as a sign of too much hand-washing as I am a nurse, I’ve never heard of such a diagnosis.

    I stopped the medication on my own. This medication has serious side effects which need to be made aware to MD’s to be aware of symptoms. I will seek medical advice as to other medications to assist with high blood pressure.

  13. Charlene
    Ringgold, GA 30736
    Reply

    I took my 85-year-old mother to the Emergency Room today. She has been on Lininopril for a month. This morning her tongue started swelling. The ER doctor said that the Lininopril caused the allergic reaction. They gave her a steroid through her IV and gave bendryl in IV.

    • Sandra
      Texas
      Reply

      Did your mother get over the allergic reaction? My 85 year old mother had a very similar reaction but her swelling did not go down. She passed away 14 days later.

  14. barbara brandt
    new jersey
    Reply

    I have the cough again. I was off all my blood pressure meds for about one month because I suspected the pharmacist was correct and the doctor I was seeing was wrong. She did an EKG and said I was having trouble breathing and gave me inhaler. I went back on ace inhibitor and another medication I took for years for high blood pressure and started stomach cramps, problems with bowel and urinating and decided to eat less. Then the cough came again and vomiting and choking. Had fatigue and exhaustion for months. Was in a clinic and asked for help with osteoporosis (advanced in hips) and no help. Went to doctor, same thing. I though the fatigue was due to that. I have to keep on working in my yard and in my house (old house) and so I plan a day around how long I can work before I have to sleep or at least stop and rest. No doctor for two years has helped with the osteo. A clinic in Princeton said I could have shots for that but every time I came in to get the shot, no one knew about it. I was only allowed to join for 6 months because I had Medicare and they did not know if they wanted to take Medicare in a Clinic to help residents with low income. Absurd! I brought in my bone scan but only the nurse that wanted to give shots saw it. When I begged for some help with the osteo, they told me to come back in 3 months. By then, I would not be a member. Now my spine is in big trouble and I need a back brace. I am hoping I can qualify for QMB and get help with the cost of a doctor. But the problem with the blood pressure has increased now. I have no doctor any more. I will try to go to Hunterdon Medical Center for help but I live in a different county so not sure I will qualify for their program. Meanwhile, no more medications for high blood pressure or hypertension.

  15. Regina
    Pooler, GA
    Reply

    I took Lisonopril 10 mg for one week. The first couple days I was super happy to see my blood pressure go down that I ignored a sort of sick feeling I was having. I figured it takes a little while to get used to mild common side effects until they go away. It didn’t go away and it got worse. I couldn’t tell what part of my abdomen was hurting. At first I thought I might try to help myself move my bowels but that didn’t help with the increasing pain in my abdomen. I tried eating less since I felt like I was so bloated but the pain still increased. I tried drinking a lot of water and still no relief. The pain became so bad my coworkers became super concerned. I finally gave in and researched Lisonopril and abdominal pain. I immediately stopped taking it. I went to my Dr and told her all my symptoms. She took an X-ray and I’m still waiting on results. I also told her that it was two days of no meds and tummy feels better but not exactly right yet. My blood pressure went right back to where it was. I mentioned my birth control pills and she said she it’s up to me if I want to see if blood pressure goes down from stopping all meds. She seemed so confused about the abdominal pain and stated that Lisonopril doesn’t cause intestinal problems. Maybe I’m her first patient that this has happened to. Today I woke up with sore muscles as if I worked out with weights. Makes me wonder if my heart muscle is sore too. I feel drained and tired. Also today my tummy doesn’t hurt.

  16. Virginia
    CA
    Reply

    Lisinopril almost killed my partner. He had off and on swelling, fainting spells, angioedema, itchy swollen throat at times, vocal changes due to swelling, all symptoms starting with being prescribed lisinopril. I told his doctor and he saw him and was prescribed epi-pen. However, he had symptoms once more and then despite administering epi-pen and benedryl, paramedics coming and treating him, and ER further treatment, he had to be intubated and put on mechanical ventilation. SO, doctor did not spot it–drug store did not flag that this reaction could happen when both sertraline and ACE inhibitor prescribed, and partner was loathe to go to ER, while also believing the epi-pen could “cure” him.
    It is admin. epi-en, AND call 911; always be seen in a med. setting; review all medications; at the very least speak to your pharmacists.
    There can be various combinations of symptoms, random occurrences, and different causes BUT I’d rather be safe than sorry. Report the symptoms immediately if taking any meds, call an advice nurse if in doubt, ALWAYS call ER when having to use EPI as it is just an emergency measure with two doses beg the max you should deliver, and if you feel your throat swelling, move on this FAST!

  17. Carol A.
    Reply

    I Do NOT have high blood pressure. My Dr put me on lisinopril for my diabetes type 1 which is very much under control. No pills . She also said I should take a low dose aspirin daily. I have after 2 weeks developed a slight cough and today a headache and had to have a nap. I am 63. My dad became allergic to aspirin in his late 40s and he also had congestive heart failure. I’m not very happy about the reason I am even taking this drug and worry that it will possibly cause me more harm than good?

  18. Carol A.
    Seattle Wa
    Reply

    My Dr put me on for a 30 day trial. I DO NOT have high blood pressure. She said that as a type 1 diabetic under super control no pills it is recommended along with a small dose aspirin. I am worried that since my Dad was allergic to aspirin his tongue swollen and this was in his forties and he also had congestive heart failure that this drug I don’t even need. I do have a slight cough since starting lisinopril and today I have a headache and needed a nap. I am 63.

    • The People's Pharmacy
      Reply

      Lisinopril can cause cough; be sure to ask your doctor more about the benefits and risks of this regimen.

  19. Natalie
    Iowa
    Reply

    I started lisinopril a week ago, the first 3 days I was dizzy even when I was laying in bed I was way way tired, I kept on taking then hoping to feel better once they got through my system. But I get pain in my knees and cramps in my stomach, and for the last 3 night I can’t sleep, I feel tired but can’t sleep I lay there tossing and turning, I have also been in a sad and depressed mood crying and don’t know why. I am 28 years old and my blood pressure is normally 170/120 I have been on a couple different pills omg, it takes so long to respond to starting a new pill and I’m tired of being tired.

  20. Angela
    Texas
    Reply

    Following this thread for updates.

  21. Patty C.
    75061
    Reply

    Have been on Lisinopril for 6 wks. Have a bad, bad dry cough. Was taking 10 mg and have started breaking it in half for the last 2/days.

    3 days ago I woke with a stiff neck, and it seems to be getting worse. Is this a side effect?

    I get dizzy going out and don’t feel good in general. Doctor is on vacation. His fill-in called in Lasarta. After reading about effects, I didn’t pick up the prescription. Now I don’t know what to do. My cheek hurts, too.

    Forgot pill yesterday, and my blood pressure got very high !!! Its 4 A.M. and it’s up again. This is a nightmare !!!

  22. Robin
    Denver
    Reply

    I had been taking Lisinopril for several years without any problems. One evening a couple of years ago, I developed severe anaphylaxis with no warning. I had difficulty breathing and lost control of my bowels and bladder. When my family saw my swollen face and lips as well as my mental confusion and filth they called an ambulance. I was hospitalized for 3 days. My allergy tests confirmed it was the Lisinopril. The reaction can take just moments.

    I know most people don’t get a reaction like this, but, my question is why risk it? There are other drugs. What I remember clearly was the EMTs talking and asking questions. I didn’t feel like answering them. They were annoying me, and I just wanted to be left alone. Finally one threatened to intubate me. I just said “no”. That was all they wanted. My doctor told me later, that kind of apathy was a sign that I was dying.

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